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General NPI Number Information
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NPI Number | 1376051656
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Entity Type | Organization
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Legal Business Name | SPRING ORTHODONTICS
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Dates
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Enumeration Date | 01/20/2018
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Last Update Date | 01/20/2018
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Provider Practice Location Address
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Address Line | 800 HILLGROVE AVE STE 200
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City | WESTERN SPRINGS
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State | IL
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Zip | 60558-1566
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Country | US
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Telephone | 708-505-2525
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Fax |
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Provider Business Mailing Address
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Address Line | 603 E 1ST ST
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City | HINSDALE
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State | IL
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Zip | 60521-4702
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | ROHINI MATHRANI
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Credential | DDS
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Telephone | 847-975-5168
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223X0400X
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Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
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License Number | 021002382
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License Number State | IL
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